Plus, experts at the AMA meeting in Chicago tell you what to do if you can’t get H1N1 vaccine for PQRI Measure 110 or other vaccine measures.
Question: My internist decided not to put a patient on Coumadin because the patient has a higher risk of falling than from having a stroke. Our group participates in PQRI easure 33 for risk of clotting. How can I indicate performing the measure wasn’t appropriate so that the physician isn’t penalized for not prescribing the anti-blood clotting medication?
Answer: You should report the measure and append the denominator exclusion indicator 1p. This indicator shows the physician chose not to prescribe the drug due to the art of medicine, or factors that make performing the measure not clinically appropriate.
If, however, the internist prescribed Coumadin but the patient isn’t taking it because she can’t afford the medication, you instead would use 2P. Your group can then have the patient referred to a social worker to help the patient figure out her financial hardship and find a way to obtain the medically necessary drug.
The third denominator exclusion in this group is 3p, which shows the medication was not available. Read on to learn what to do when you can’t get H1N1 vaccine supply …
For instance, if you’re reporting on giving H1N1 vaccine, but no product was available since delivery mechanisms sent the vaccine to clinics, not your practice, you could use the universal vaccine measure 110 with 3P for no vaccine available.
These three exclusion denominators show why things like art of medicine, education, or economic reason prevented the physician from performing a given measure, explained Susan Nedza, MD, MBA, FACECP, at the final session of the AMA CPT 2010 symposium. The patients who fall under these reasons do not effect physician’s quality of care percentage as shown in a registry for an individual’s or group’s measure.
“Physicians for the most part are receptive to using these now,” reported Ronald A. Gable, MD, CPT Performance Measures Advisory Group, in the PQRI presentation in Chicago. Denominator exclusions used to be a negative allowing physician to say why opted out of a measure. Now they are a positive that indicates why performing the measure was not appropriate so that quality of care percentage not negatively impacted.
AUDIO TRAINING EVENT: 2010 Primary Care Coding & Reimbursement Update. With Jill Young.
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